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Biomedical subjects

Jennifer Cahill

Publications and source records attributed to Jennifer Cahill.

12 recordsLinked to original sources
PubMed2007

Occupational autoeczematization or atopic eczema precipitated by occupational contact dermatitis?

Autoeczematization is characterized by the sudden dissemination of a previously localised form of eczema. While widely described, most cases reported have followed chronic, localized stasis dermatitis. In this study, we describe the clinical scenario of occupational contact dermatitis (OCD) triggering endogenous-like eczema in atopic individuals, who often have not had eczema since childhood, if at all. These cases appear similar to previously described cases of autoeczematization. To show this clinical scenario, a series of 6 patients is presented from the Occupational Dermatology Clinic in Melbourne, Australia. These workers initially developed OCD, usually affecting the hands, which then precipitated a flare of more generalized eczema. This appeared clinically consistent with atopic eczema (AE), and often became recurrent, and sometimes persistent. OCD can precipitate a flare of more generalized eczema, in a pattern consistent with AE, which may then persist. The clinical scenario is similar to that described for autoeczematization. It is possible that the pathophysiology, when clarified, will prove to be similar. Workers' compensation issues may become complicated for these patients, as the relationship between their generalized eczema and their occupational exposures may not be readily apparent. As a result, the work relatedness of their condition may not be recognized.

Adolescent↗
PubMed2006

Allergic contact dermatitis to thiourea in a neoprene knee brace.

SUMMARY An elderly woman developed an itchy, weeping, erythematous, papular eruption, confined to the skin under her neoprene knee brace. Allergic contact dermatitis to diethylthiourea and to her neoprene knee brace were diagnosed by positive patch test reactions. Allergic contact dermatitis from thioureas may be underdiagnosed, as they are not tested as part of the standard patch test series. Clinicians are encouraged to consider this diagnosis in patients with reactions to synthetic rubber, especially neoprene.

Aged↗
PubMed2005

Prognosis of contact dermatitis in epoxy resin workers.

Between January 1993 and February 2002, 40 of 1354 (3%) workers who attended a tertiary referral occupational dermatology clinic were diagnosed with allergic contact dermatitis (ACD) from epoxy resin systems (ER). 20 of these patients were followed up at least 2 years post-diagnosis to establish prognosis. Characteristics collected at diagnosis, including age, atopic status and severity, were compared between the follow-up and not followed-up groups. No significant differences were observed. A clinician contacted patients and administered a telephone questionnaire based on variables identified from the literature, which were considered of importance for prognosis. All patients reported improvement of their skin condition since diagnosis. 12 of the 20 {60%[95% confidence interval (CI) 56-94%]} patients had applied for workers' compensation; all of these claims were successful. 16 had ceased working with ER. Of these, 9 [56% (95% CI 29-80%)] reported complete healing and 7 [44% (95% CI 19-70%)] reported ongoing dermatitis. Although no conclusions could be drawn because of the small sample size, factors that may be associated with a poor prognosis were age, atopy, duration of symptoms and severity at diagnosis. The prognosis of ACD from ER is not always favourable, even if a worker ceases exposure.

Adult↗
PubMed2005

Incidence and prevalence rates for occupational contact dermatitis in an Australian suburban area.

Occupational contact dermatitis (OCD) regularly causes high levels of worker morbidity; however, this is often not reflected in available statistics. This study aimed to collect and verify OCD reports/referrals and generate disease estimates for a defined geographical area in Melbourne, Australia. Two methods of data collection were used. In the first method, 30 general practitioners (GPs), 2 dermatologists and 1 dermatology outpatient clinic within a defined area reported each worker with suspected OCD seen as part of routine practice. With the second method, workers living in the area who were referred to a tertiary referral OCD clinic were included in the study. An occupational dermatologist used a gold standard process that included diagnostic patch testing to verify suspected cases. The incidence rate for confirmed cases was 20.5 per 100,000 workers [95% confidence interval (CI): 13-32.1]. The 1-year-period prevalence rate was 34.5 per 100,000 (95% CI: 24.4-48.7). The positive predictive value (PPV) was highest for the occupational dermatology clinic referrals [63% (95% CI: 49-76%)] compared with reports from the dermatologists/dermatology outpatient clinic [55% (95% CI: 36-74%)] and from GPs [43% (95% CI: 29-59%)]. This study utilizes reports from GPs and dermatologists to provide OCD disease estimates and validation data for an OCD disease register.

Adult↗
PubMed2005

Occupational allergic contact dermatitis to bisphenol F epoxy resin.

A 30-year-old man presented with eyelid dermatitis and was diagnosed with occupational allergic contact dermatitis to an epoxy resin based on the monomer diglycidyl ether of bisphenol F. He did not react to the standard epoxy resin based on bisphenol A, but reacted to a diluted sample of epoxy resin taken from his workplace, an adhesives manufacturing plant. The diagnosis would not have been made had he not brought samples from work, which were patch tested after appropriate dilution. The material safety data sheet provided additional evidence that the epoxy was not based on bisphenol A. The patient's symptoms subsided after avoidance of the identified product.

Adult↗
PubMed2005

Allergic contact dermatitis to quaternium 15 in a moisturizing lotion.

A 56-year-old nurse from a rural area presented with a 12-month history of hand dermatitis. She had previously been patch tested by a local medical practitioner with the thin-layer rapid-use epicutaneous test, which had shown allergies to quaternium 15 and formaldehyde. After testing, she was prescribed methylprednisolone aceponate 1 mg/g cream by the medical practitioner, but was not informed that quaternium 15 is contained in the Microshield moisturizing lotion she was using at work. When her dermatitis persisted, she saw a dermatologist, who advised her to avoid the Microshield moisturizing lotion, and use a waterless hand cleanser on return to work. The diagnoses were firstly allergic contact dermatitis from quaternium 15 in the moisturizing lotion, and secondly irritant contact dermatitis from nursing work. This case highlights both the presence of quaternium 15 in a product commonly used in health-care settings in Australia, and the importance of offering informed, appropriate advice to patients following patch testing.

Dermatitis, Allergic Contact↗
PubMed2005

Cutaneous manifestations of systemic disease.

BACKGROUND: While most patients who present with a rash have no associated systemic illness, many systemic illnesses have skin manifestations at some stage. OBJECTIVE: This article uses case vignettes to illustrate a problem oriented approach to five commonly presented skin conditions that have common and varied systemic associations. A logical sequence of management for each case is provided. DISCUSSION: Often the skin manifestations of systemic disease are vague and nonspecific such as the toxic erythema that might follow a viral infection or a drug eruption. Sometimes it is the systemic manifestations that are vague and nonspecific, while the skin manifestations are highly specific and define the illness. There is currently no useful classification for cutaneous manifestations of systemic disease.

Adolescent↗
PubMed2004

Identification of a peptide binding motif for secreted frizzled-related protein-1.

Secreted Frizzled-related proteins (sFRPs) bind Wnts and modulate their activity. To identify putative sFRP-1 binding motifs, we screened an M13 phage displayed combinatorial peptide library. A predominant motif, L/V-VDGRW-L/V, was present in approximately 70% of the phage that bound sFRP-1. Use of peptide/alkaline phosphatase chimeras and alanine scanning confirmed that the conserved motif was important for sFRP-1 recognition. The dissociation constant for a peptide/sFRP-1 complex was 3.9 microM. Additional analysis revealed that DGR was the core of the binding motif. Although Wnt proteins lack this sequence, other proteins possessing the DGR motif may function as novel binding partners for sFRP-1.

Alanine↗
PubMed2004

Allergic contact dermatitis to methylprednisolone aceponate in a topical corticosteroid.

A 42-year-old registered nurse presented with a recurrent history of multifactorial hand dermatitis, which had ceased to respond to the topical corticosteroid that she was using. Patch testing revealed strong reactions to both Advantan Fatty Ointment (Commonwealth Serum Laboratories, Melbourne, Australia), and its active ingredient, methylprednisolone aceponate. Methylprednisolone aceponate is one of the more sensitizing topical corticosteroids and is becoming increasingly recognized as a significant allergen.

Adult↗
PubMedDate not supplied

The prognosis of occupational contact dermatitis in 2004.

The prognosis of occupational contact dermatitis (OCD) takes into account the extent of healing, effect on quality of life and employment, and financial costs for both the individual and the wider community. We reviewed 15 studies published between 1958 and 2002, reporting the complete clearance of dermatitis (range of 18-72%). 9 of the 15 studies reported a clearance rate of between 18 and 40%. Improvement was reported as an outcome in 3 studies between 1991 and 2002 (range of 70-84%). A number of common variables were identified as of possible influence. These include age, sex, atopy, patient knowledge, disease aetiology, duration of symptoms and job change; clinical, financial and social issues are also described. All of these factors need to be considered when managing a patient with OCD. Improved patient knowledge and early diagnosis may be associated with improved prognosis, whereas job change does not make a significant difference. Some patients will develop persistent post-occupational dermatitis, which has important implications for prognosis and workers' compensation. Only a small proportion of eligible patients receive workers' compensation, even though financially supported healing time soon after diagnosis may result in an improved prognosis.

Cost of Illness↗
PubMedDate not supplied

Persistent post-occupational dermatitis.

Wall and Gebauer (Contact Dermatitis 1991: 24: 241-243) first described persistent post-occupational dermatitis (PPOD) as ongoing dermatitis for which there is no obvious present cause, precipitated by prior occupational contact dermatitis (OCD). We propose that individuals exhibiting PPOD lose the capacity for resolution of their condition upon removal from exposure to causative agents and subsequently develop persistent dermatitis, which can be continual or intermittent. Accordingly, we suggest modification of criterion 6 of the OCD criteria developed by Mathias (J Am Acad Dermatol 1989: 20: 842-848): 'Removal from exposure initially leads to improvement of dermatitis, however, over time there may be incomplete or no improvement, despite removal from exposures at work'. To satisfy the definition of PPOD, individuals must meet at least 4 of the 7 criteria, including the altered criterion 6. We present 6 cases of PPOD exemplifying these scenarios, which met the altered Mathias criteria. In some cases, subsequent failure to recognize the initial work relatedness of their skin conditions resulted in the termination of workers' compensation benefits. This situation is particularly relevant in the Australian context. The diagnosis of PPOD needs to be considered in all individuals with work-initiated dermatitis who present with ongoing endogenous-like eczema.

Adult↗